The State of Public Health in Arkansas in 2017
by NATHANIEL SMITH , MD , MPH , DIRECTOR AND STATE HEALTH OFFICER
To facilitate the mission of protecting and improving the health and well-being of all Arkansans in 2017 , the Arkansas Department of Health ( ADH ) utilized a strategic plan ( available at www . healthy . arkansas . gov ) to focus on six important public health issues : childhood obesity , hypertension , tobacco , immunizations , teen pregnancy , and mental and community wellness .
Arkansas ranks highest in the nation for adult obesity , and more than one-third of Arkansas children and adolescents are overweight or obese . The ADH continues to play a leadership role in Healthy Active Arkansas ( HAA ), a public-private partnership endorsed by Governor Asa Hutchinson and focused on promoting healthy weight and an active lifestyle . This year funding received from the Blue and You Foundation allowed us to launch an enhanced HAA website , print and disseminate a newly developed Sugar Sweetened Beverage Reduction Toolkit , and place additional questions on the Arkansas Behavior Risk Factor Surveillance Survey related to sugarsweetened beverage reduction .
One of the strategies in the HAA framework to reduce obesity is promoting breastfeeding . Arkansas is well below the national average for initiation of breastfeeding — our rate for “ ever breastfed ” was 68.4 % in 2016 compared to 81.1 % nationally . Through ADH ’ s network of local health units , the Special Supplemental Food Program for Women , Infants and Children ( WIC ) provides nutritional counseling , breastfeeding education , and peer counseling support to pregnant and postpartum women . Through WIC , ADH provides support to low-income women , whose rates of breastfeeding are lower than the state average , and offers training for health professionals to become Certified Lactation Counselors . Over 140 health care providers have participated in this training over the past two years .
In seven rural counties , ADH has expanded its collaborations with primary care physicians to provide community team-based care where public health nurses provide follow-up monitoring for patients with hypertension and diabetes . This year marked the addition of a hospital partnership with Jefferson Regional Medical Center , with funding support from Humana , for implementing hypertension team-based care through the emergency department and inpatient discharges .
Arkansas ranks first and fifth among states for the highest heart attack and stroke death rates respectively . ADH has received support to expand the trauma system to include stroke and STEMI ( ST- Elevation Myocardial Infarction ). Efforts to address stroke include : ( a ) a program to increase participation in the Stroke Registry ; ( b ) certification of 45 new instructors and over 300 providers of the Advanced Stroke Life Support ( ASLS ) curriculum ; ( c ) certification of seven hospitals as ASLS training centers ; d ) development of an online quality improvement audit survey for pre-hospital providers to improve stroke care ; ( e ) onsite stroke registry performance reviews ; and ( f ) a series of quality improvement webinars to give hospitals performance-improvement tools for optimizing patient outcomes . Efforts to reduce STEMI include : ( a ) regional application of standards of care to optimize patient outcomes of emergency medical services ( EMS ) and hospitals ; and ( b ) a pilot program in three regions ( northeast , north central , and southwest ) to improve care coordination between EMS and hospitals .
The tobacco program focused on preventing youth from initiating tobacco use and helping adults to quit . Arkansas data showed a drop in adult smoking to 23.6 % and youth smoking to 15.7 %, continuing a downward trend . In 2017 , the Tobacco Prevention and Cessation Program began social media programs focused on rural youth , enhanced its programs statewide by collaborating with Arkansas Children ’ s Hospital , and strengthened promotion of quitting among those who prefer not to use counselling or medication . Plans were developed to set up pilot programs for counseling in pharmacies in Arkansas as an alternative to telephone Quitline services . Raising the legal age for tobacco sales from 18 to 21 ( a policy known as “ T21 ”) significantly decreases smoking initiation among young people and is being implemented in several states and a growing number of local jurisdictions . During the 2017 legislative session , the ADH supported a T21 bill . Although the bill was unsuccessful this time , many legislators were educated on T21 and expressed their support .
The ADH immunization program successfully managed a large outbreak of mumps in northwest Arkansas , rolling out a third-dose MMR program that has now become a CDC best practice . To improve vaccine acceptance , the exemption process is now being offered online and will be further modified to make sure those who exempt their children from immunizations are provided up-to-date facts on vaccine-related topics .
The ADH continues to focus on reducing unintended pregnancies , with a particular emphasis on decreasing teen pregnancies . The ADH received additional funding from the Arkansas Legislature to increase the availability of Long Acting Reversible Contraception ( LARC ). During the 2017 calendar year , 4,367 women seeking contraceptive services from their local health unit received a LARC .
In the area of mental and community wellness , the ADH created a new branch , Substance Misuse and Injury Prevention , to address the opioid epidemic . The ADH was awarded funding from the U . S . Department of Justice to increase Prescription Monitoring Program ( PMP ) data sharing , analysis and use ; increase public awareness of risks of opioids through an educational media campaign ; and offer additional opioid education to prescribers . Enhancements to the PMP will include Prescriber Comparison Reports , or anonymously comparing prescribers to others in the state in their area of specialty .
With funding support from the CDC , the ADH is assisting hospitals and health care providers in addressing health care associated infections and antibiotic stewardship . In 2017 , Arkansas increased by 60 % the number of hospitals that meet all seven antibiotic stewardship core elements . To improve rapid detection and response to emerging drug-resistant organisms , the ADH also increased capacity in the Public Health Laboratory to provide facilities and providers with guidance during outbreaks and in developing prevention plans . For example , the ADH is ramping up testing to include whole genome sequencing of all Listeria , Salmonella , Campylobacter and E . coli isolates and simultaneously monitoring these isolates for resistance genes .
We appreciate the many national and state partnerships that allow us to implement our strategic plan and to execute our mission .
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